Anxiety disorders are common, often have a chronic course and frequentlycoexist with other psychiatric disorders. Psychological therapy isrecommended as first-line treatment, but equitable access remains achallenge. This month's Cochrane Corner review assesses the evidence for theefficacy of therapist-supported cognitive-behavioural therapy (CBT) foranxiety disorders delivered via the internet. Although internet delivery oftherapy is attractive for many reasons, and the results of this preliminaryreview suggest that it is efficacious, this is a rapidly expanding field.Further updates of this review will include more evidence to support orrefute the use of this new method of treatment delivery, either alongside orin preference to standard face-to-face CBT.

Although medical experts are valued in the administration of justice, thecases in the UK of Meadow and others, including most recently Pool, have allcontributed to understandable anxiety on the part of doctors who carry outcourt work. This article uses an in-depth analysis of these cases anddetails of some other medical regulatory cases to draw out some lessons forpotential medical expert witnesses. Although the most recent judgment inPool leaves a number of unanswered questions, steps are identified that maybe taken to reduce the risk of regulatory investigation by the GeneralMedical Council.

This piece seeks to complement Professor Rix's article on expert competenceand professional misconduct by examining a related issue, namely theincreasingly strict approach of the criminal courts to the reception ofexpert evidence. It considers recent case law, rules of procedure andlegislation, and addresses both the admissibility of expert evidence and theduties of expert witnesses.

This article discusses the importance of residence capacity – anindividual's mental capacity to decide where they should live – and suggestshow it should be assessed. People with dementia or intellectualdisabilities, as well as those with other mental disorders, are sometimesrequired to make this decision. Assessments of capacity must be conductedwith considerable care, given the implications for the individual and fortheir human rights. The assessment must be objective and functional: theassessor must be able specifically to demonstrate a lack of decision-makingability. Yet assessments of capacity still require evaluative decisions tobe made. We suggest some basic information that should be conveyed to theperson faced by the prospect of a change of residence where there is a doubtabout capacity.

Assessment of mental capacity is, or should be, a regular part of dailyclinical practice in general hospitals. It is both particularly importantand potentially complex in relation to an older person with dementia wishingto return home despite concern over perceived risk. Case law provides someguidance, but an ethical duty remains for clinicians to develop and honetheir professional judgement in this increasingly important area ofpractice.

Persistent major depression that does not respond to adequate first- orsecond-line treatment is a common problem in psychiatry. This articleupdates evidence on recommended treatment strategies and reviews theprospects of more experimental approaches. The main pharmacologicaldevelopment in recent years has been the demonstration that several atypicalantipsychotic drugs are effective adjunctive agents in improving symptoms indepression unresponsive to selective serotonin reuptake inhibitors, althoughtheir adverse effect burden is high. There is optimism about novelpharmacological strategies based on glutamatergic and anti-inflammatorymechanisms. It is important to combine drug and psychological treatmentswhenever possible. With persistent therapeutic engagement, the majority ofpatients remit eventually, but subsequent relapse remains a problem.Clinicians should pursue an active and collaborative treatment plan thatmakes use of all effective therapeutic modalities and continues into therelapse-prevention phase.

Serotonin syndrome (serotonin toxicity or serotonin toxidrome) is apotentially serious and theoretically predictable reaction that appears tobe rarely diagnosed in practice in the UK. Some symptoms of serotoninsyndrome overlap with features of other presentations in psychiatry and thusmay be misattributed to mental illness (‘diagnostic overshadowing’).Further, there may be diagnostic dilemmas in patients on combinations ofdrugs, those receiving drugs with previously unknown serotonergic propertiesor where there are drug interactions. Prescriber vigilance and holisticreview of the patient, including the pharmacotherapy, may be helpful inavoiding progression of serotonin syndrome to more serious outcomes.

This article summarises new research, together with core features, courseand outcome of schizophrenia with onset in childhood and adolescence, andinvestigates its neurobiology and continuity into adult life. It concludesthat, in conformity with other disorders of childhood, adult-baseddiagnostic criteria have validity in adolescence. Sadly, the disorder has apoorer outcome when onset is in youth.

Akathisia is a common and distressing side-effect of antipsychoticmedication. The treatment of this condition is difficult and options arelimited. This review of the literature was performed to develop anevidence-based algorithm for the management of antipsychotic-inducedakathisia. There is limited high-level evidence to support the use ofanticholinergics. Centrally acting β-adrenergic antagonists are potentialtreatments, although their use is limited by troublesome side-effects.Long-acting benzodiazepines and mirtazapine are potential well-toleratedtreatments for the acute management of akathisia.

Economic evaluation involves the comparative analysis of the costs andconsequences of alternative (different) treatment options. Economicevaluations provide decision makers with information about the relativevalue for money, or cost-effectiveness, of various treatment programmes. Therelative cost-effectiveness of new interventions is a key consideration inhealth technology assessments by the UK's National Institute for Health andCare Excellence, and economic evaluations alongside randomised controlledtrials are routinely requested by funders such as the National Institute forHealth Research. This article outlines some of the key concepts and issuesin the economic evaluation of mental healthcare.

Previous studies have demonstrated that smartphones are useful tools ineveryday, evidence-based medical practice. This article gives an overview ofthe current use in psychiatry of smartphone apps aimed at patients and thegeneral public, highlighting associated benefits and disadvantages. It alsooutlines how practising psychiatrists could embrace such technologies at anindividual, organisational and national level.

Many people with mental health problems spend a large proportion of theirlife online and an increasing number of apps address mental health andwell-being. This article offers reasons why psychiatrists should learn howto use mental health apps to enhance patient care and gives some caveats forboth professionals and patients regarding their use.